| NPI | 1871159095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARDA AVERNETTE LONG Administrator 336-290-2538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2020-01-23 |